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Module 5
Safety
418
Nursing
Undergraduate 1
02/12/2019

Additional Nursing Flashcards

 


 

Cards

Term
Category C agents are
Definition
emerging pathogens that could be engineered for mass dissemination because of their availability, ease of production and dissemination, mortality rate, and ability to cause a substantial health impact.
Term
Category C
Definition
- H1N1 INFLUENZA
- Hantavirus
- HIV/AIDS
- Nipah virus
- SARS
Term
Chemical agents
Definition
- blister
- blood agents
- choking agents
- incapacitation agents
- nerve agents
Term
Nuclear weapons
Definition
- fissure
- fusion
Term
Nuclear weapons
Definition
- cutaneous burns
- acute radiation syndrome
Term
Biologic weapons - category A
Definition
anthrax
smallpox
salmonella
typhoid
Term
Biologic weapons - Category A
Definition
Highest priority diseases that pose a risk to national security, are easily transmitted, have high morbidity and mortality, would have a major public health impact and cause panic, and require special public health preparedness.
Term
Biologic weapons - Category B
Definition
Moderate priority diseases with lower morbidity and mortality and more difficult to disseminate.
Term
Category B
Definition
- E. coli
- Ricin
- S. areus
- Typhus
- viral encephalitis
- abrin toxin
- epsilon toxin
Term
Primary survey for emergency care
Definition
- airway/cervical spine
- breathing
- circulation
- disability/CNS
- exposure
- triage guidelines
- basic first aid
- cardiac arrest and cpr
Term
what guides the primary survey?
Definition
abcde principle
Term
if airway is blocked
Definition
inspect for anything that may be causing and obstruction
Term
opening the airway of a pt that is unresponsive and/or with suspicion of trauma
Definition
a modified jaw thrust maneuver
Term
use during resuscitation
Definition
a bag-valve-mask with a 100% O2 source
Term
interventions geared toward restoring effective circulation
Definition
- cpr
- direct control (direct pressure to visible external bleeding)
- obtaining iv access
- infusions of fluids/blood
Term
typical resus fluids, iv, catheter
Definition
- lactated ringer
- 0.9% NS
- antecubital fossa
- a large bore needle catheter
Term
interventions to alleviate shock
Definition
- admin O2
- apply pressure if bleeding
- raise the feet
- admin blood/iv fluids
- monitor vitals
- provide reassurance and support for anxiety
Term
AVPU pneumonic for LOC
Definition
A - alert
V - response to voice
P - response to pain
U - unresponsive
Term
what does hypothermia lead to?
Definition
vasoconstriction and impaired oxygenation
Term
emergent triage
Definition
a life or limb threatening situation
Term
urgent triage
Definition
a ct should be treated soon, but that the risk is not life threatening
Term
a nonurgent case
Definition
can generally wait for an extended length of time w/o serious deterioration
Term
triage under mass casualty conditions
Definition
a military form of triage that is implemented w/a focus of achieving the greatest good for the greatest number of people
Term
Emergent (Class I)
Definition
a red tag indicating an immediate threat to life
Term
Urgent (Class II)
Definition
id with a yellow tag indicating major injuries that require immediate txt
Term
Nonurgent (Class III)
Definition
green tag, minor injuries that don't require txt
Term
Expectant (Class IV)
Definition
black tag, expected and allowed to die
Term
what to assess for fractures and splinting
Definition
- swelling, deformity, skin integrity
- temp, distal pulses, mobility
- reassess neurovascular status after splinting
Term
sprains
Definition
- refrain from wt bearing
- ice
- compression dressing to minimize swelling
- elevate
Term
ss of heat stroke
Definition
- hypotension
- tachypnea
- tachycardia
- anxiety
- confusion
- unusual behv
- seizures
- coma
Term
ss of frostbite
Definition
white, waxy areas on exposed skin and tissue injury occurs, full or partial thickness
Term
give for frostnip and frostbite
Definition
pain meds and a tetanus vaccination
Term
warming a frostbite victim
Definition
100.4 - 105.8F bath water
Term
ss of hypoxia
Definition
- n&v
- dyspnea
- anorexia
Term
interventions for hypoxia
Definition
- admin O2
- descend to a lower altitude
- steroids and diuretics
Term
what can hypoxia progress to?
Definition
cerebral and pulmonary edema
Term
cardiac arrest
Definition
- the cessation of cardiac function
- the absence of the carotid pulse in the person 1yr and older
- the absence of the brachial pulse in infants up to 1yr
Term
assessment findings of a pt in cardiac arrest
Definition
- skin has ashy appearance
- no respirations
- pupils dilated
Term
the cause of nontraumatic cardiac arrest in 80-90% of victims
Definition
ventricular fibrilation
Term
pulse-less electrical activity (PEA)
Definition
the presence of electrical activity but not sufficient enough to stimulate effective cardiac contractions
Term
in children and infants, cardiac arrest is often secondary to what?
Definition
hypoxemia or shock
Term
when is defibrillation used for a pt undergoing cardiac arrest?
Definition
ventricular fibrillation and ventricular tachycardia
Term
the goal of basic life support (BLS)
Definition
to provide O2 to the vital organs until appropriate advanced resuscitation measures can be initiated or until resuscitative efforts are ordered to be stopped
Term
the goal of advanced cardiac life support (ACLS)
Definition
the return of spontaneous breathing and circulation
Term
when a defibrillator is immediately available and v-fib or v-tach is confirmed, it can be used
Definition
prior to the initiation of cpr
Term
the amt of rescue breaths w/o chest compressions for an adol or adult
Definition
- 1 breath every 5-6 secs
- 10-12 breaths/min
Term
the amt of rescue breaths w/o chest compressions for an infant and child
Definition
- 1 breath every 3-5 secs
- 12-20 breaths/min
Term
the amt of rescue breaths given during cpr with an advanced airway, for all ages
Definition
- 1 breath/ 6-8 secs
- 8-10 breaths/min
Term
the med given for VF or pulseless VT
Definition
- epi 1mg IV push every 3-5 mins
or
- vasopressin 40 units IV x 1 only
- switch to epi if no response
Term
other meds that can be considered for VF or pulseless VT
Definition
- amiodarone hcl (Cordarone)
- lidocaine hcl (Xylocaine)
- mag sulfate
- procainamide (Procan SR)
- na bicarb
Term
the amount of defib current that should be delivered for VF or pulseless VT
Definition
200, 300, 360 joules
Term
if PEA rate is slow (bradycardic) what should be admin, and what is the max dose?
Definition
atropine 1mg IV every 3-5 mins
max dose is 0.04mg/kg
Term
the most common causes of pulseless electrical activity (PEA)? the H's?
Definition
- hypovolemia
- hypoxia
- hydrogen ion accumulation resulting in acidosis
- hyper or hypokalemia
- hypothermia
Term
the most common causes of PEA? the T's?
Definition
- tablets/ drug overdoses
- tamponade (cardiac)
- tension pneumothorax
- thrombosis (coronary or pulmonary)
Term
alpha receptor sites and response
Definition
- activate in the arterioles of the skin, viscera and mucous membranes, and veins
- leads to vasoconstriction
Term
beta receptors site and response
Definition
- heart stimulation leads to increased HR, inc myocardial contractility, inc rate of conduction through the av node
- activation of the receptors in the kidney leads to the release of renin
Term
treated first during a disaster
Definition
pts who are seriously injured and have the greatest chance of full recovery
Term
dopamine site and response?
Definition
activation of receptors in the kidneys cause the renal blood vessels to dilate
Term
beta 2 receptors site and response
Definition
- heart, lungs, and skeletal muscle: vasodilation
- bronchial: bronchodilation
- liver: glycogenolysis
- skeletal muscle: muscle contraction
Term
infectious process
Definition
- incubation period
- prodromal period
- convalescent period
- period of communicability
Term
incubation period
Definition
7-10 days
Term
prodromal period
Definition
the time between the beginning of nonspecific symptoms and the onset of disease specific symptoms
Term
prodromal period - nonspecific symptoms
Definition
lethargy
low-grade fever
fatigue
malaise
Term
prodromal period - disease specific symptoms
Definition
such as a rash.
Term
prodromal period
Definition
Kids are infectious at this point and infectious disease spreads rapidly throughout a community
Term
exantham
Definition
an accompanying specific rash on the skin
Term
enanthem
Definition
an accompanying specific rash on the mucous membranes
Term
Convalescent period –
Definition
period between when the symptoms first begin to fade and when the child returns to a healthy baseline
Term
Period of Communicability:
Definition
prodromal to beginning of convalescent period
Term
ss of infection disorder on child
Definition
mouth
lesions on mucous membranes (koplik spots)
white plaques on mms (thrush)
Term
ss of infection disorder on child
Definition
skin
warm and dry from fever, rash
reddened, swollen pharynx (infectious mono pharyngitis)
gray membrane in pharynx (diphtheria)
circular, scaly ring under knee (tinea corposis)
flesh-colored papule on top of foot (plantar wart)
linear abrasions on scalp; sandlike particles on hair shafts (pediculosis)
Term
ss of infection disorder on child
Definition
nose
watery discharge (prodromal symptoms of measles)
Term
ss of infection disorder on child
Definition
swollen parotid glands (mumps)
pinpoint papules on a erythematous base, like around the mouth (herpes simplex)
paroxysmal cough (whooping cough)
oozing, honey-colored, crusty lesions on face and hands (impetigo)
crusty lesions between fingers (scabies)
Term
fomite
Definition
any nonliving object or substance capable of carrying infectious organisms, such as viruses or bacteria, and hence transferring them from one individual to another. Skin cells, hair, clothing, and bedding are common hospital sources of contamination.
Term
Portal of entry for infections
Definition
- bloodstream
- respiratory
- GI
- skin, muc memb
Term
Phagocytes
Definition
are neutrophils, and they are usually the first responders
Term
phagocytes
Definition
they produce pus (remnants of the organisms, phagocytes, and destroyed tissue)
Term
pus
Definition
usually indicates phagocytosis is occurring and the infection is resolving
Term
during septicemia
Definition
B lymphocytes and T lymphocytes are produced
Term
B lymphocytes
Definition
(humoral immunity) – they form antibodies specific to the offending antigens that either actively destroy them or active complement
Term
complement
Definition
– a special body protein that is capable of lysing cells
Term
T lymphocytes
Definition
(thymus dependent) – killer cells, they can destroy antigens either by direct contact or by the release of lymphokines (eg, interferon)
Term
High risk hospitalized children for infections:
Definition
nutritional deficit
immunosuppressed
indwelling vascular lines or catheters
receiving multiple antibiotic therapy
remain in hospital for > 72 hrs
Term
kinesthetic and visceral stimuli
Definition
orient the person to the internal environment
Term
sensory perception:
Definition
awareness and interpretation of stimuli into meaningful info. Takes place in the cerebral cortex
Term
RAS
Definition
It maintains, enhances, or inhibits cortical arousal
Term
responses to both sensory deprivation and overload
Definition
- perceptual changes (eg, mild distortions or hallucinations)
- cog changes (eg, dec concentration and prob-solving ability)
- affective changes (eg, apathy, anxiety, anger, depression, and rapid mood swings)
Term
cts at risk for sensory deprivation
Definition
homebound or institutionalized
bed rest or isolation precautions
sensory deficits
different culture
affective disorders or disturbances of the NS
certain meds that affect the NS
Term
cts at risk for sensory overload
Definition
pain
ICU
intrusive or uncomfortable eqpt
NS disorders or disturbances
Term
assessment of sensory-perception disturbance:
Definition
a nursing history to ID sensory deficits
physical
mental status
ID of at-risk cts
immediate environment
presence of clinical signs of sensory deprivation or overload
Term
NANDA nursing dx r/t a ct's sensory impairments
Definition
Sensory Perception Disturbances: Visual, Auditory, Gustatory, Olfactory, Tactile, Kinesthetic
Acute Confusion
Chronic Confusion
Impaired Memory
Social Isolation
Impaired Verbal Comms
Risk for Impaired Skin Integrity
Self-Care Deficit: Bathing/Hygiene
Impaired Home Maintenance
Risk for Injury
Term
Goals for persons with sensory-perception disturbances
Definition
maintaining or promoting the function of existing senses
maintaining or improving comm
preventing injury
avoiding sensory deprivation or overload
reducing social isolation
maintaining or restoring ability to function safely in the environment
ADLs
Term
Interventions to prevent or modify sensory deprivation
Definition
sensory overload, and sensory deficits
promoting healthy sensory function
adjusting environmental stimuli
managing sensory deficits
Term
Cts with sensory deficits need
Definition
instructions about sensory aids available to support residual sensory functions
ways to promote the use of other senses
methods to ensure safety from bodily harm
Term
NICs for sensory alterations
Definition
comm enhancement: hearing deficit
“ visual deficit
nutrition mgmt
environmental mgmt
fall prevention
body mechanics promotion
peripheral sensation mgmt
emotional support
surveillance: safety
Term
common safety hazards
Definition
- physical/mechanical
- thermal
- chemical
- radiation
- ecological
Term
common safety hazards - ecological
Definition
risks posed by changes in the environment as a result of man-made or natural changes. Air, water, and noise pollution are examples of ecological hazards.
Term
common safety hazards - radiation
Definition
exposure to the sun, heat lamps, tanning booths, and x-rays
Term
common safety hazards - chemical
Definition
agents present in a person’s surroundings that can potentially cause injury and include medications, poisons, carbon monoxide, radon, and lead paint.
Term
common safety hazards - thermal
Definition
substances that can cause burns, chills, and fire. These include gas stoves, electrical hazards, and exposure to heat, cold, and fire
Term
common safety hazards - physical/mechanical
Definition
caused by unsafe physical conditions. These include wet floors, throw rugs that slide, stairs without handrails, poor lighting, improper use of restraints, defective equipment, and unsecured firearms
Term
factors affecting safety
Definition
Age
Individual preference
Physical condition
Cultural and spiritual needs  Socioeconomic factors
Environmental factors
Psychological factors
Term
factors affecting safety - individual preferences
Definition
- lifestyle
- occupation
- risky lifestyle
- use of meds
- history of previous injuries
Term
factors affecting safety - environmental
Definition
- proximity to disaster situations
- occupational
- ergonomic
- neighborhood
- cleanliness
Term
There are four major types of chemical weapons:
Definition
nerve agents
choking/lung/pulmonary agents
cyanides
vesicants or blister agents
Term
Treatments for chemical weapon exposure include
Definition
providing for an open airway, respiratory support
antidotes
specific treatment related to the particular agent
These situations demand an immediate decontamination
Term
emergency mgmt. planning
Definition
- biological, chemical, nuclear weapons
- natural disasters
- weapons of terror
Term
There are four key steps to assessing risk
Definition
- develop a communication plan
- plan out how to tackle the emergency
- assign accountability
- Annual update reviews, individual updates for staff regarding particular events, and disaster are provided
Term
Staff education should cover the following points:
Definition
- Identification of potential agents such as anthrax, smallpox, chemical, or nuclear agents
- Mass casualty treatment protocols
- Personal protective equipment for each emergency
- Infection control practices (for example, standard precautions and decontamination).
- Identification of disaster resources and their availability
- Discussion of psychological aspects of bioterrorism (for example anxiety, paranoia, and social isolation)
- Planning for recovery and rehabilitation.
Term
hospital emergency preparedness plan
Definition
- Communication plan (within and outside the hospital)
- Protocols for individual threats to the hospital
- Mass casualty protocols and infection control policies
- Comprehensive education plan for the staff
- Identification of resources needed during a disaster
Term
tuberculosis
Definition
Etiology Agent - The bacteria Mycobacterium tuberculosis  Reservoir - Man  Portal of Exit - Via the respiratory system when the infected person coughs or sneezes  Means of Transmission - Airborne droplets  Portal of Entry- Via the respiratory system  Host - Man
Term
There are six elements in the chain of infection:
Definition
- etiological/infectious agent
- reservoir
- portal of exit
- mode of transmission
- portal of entry
- susceptible host
Term
A reservoir is
Definition
a host or source of pathogens, which can include another human, a plant, an animal, or even an inanimate object. Humans can be symptomatic or asymptomatic. People who are asymptomatic may also be called “carriers” of that disease.
Term
The portal of exit is
Definition
a route out of the reservoir. These can include the nose and mouth for respiratory diseases. The most common way a blood-borne disease can “exit” is from bleeding, insect bites, and use of syringes and needles. Other portals of exits can include the GI tract and the urethra or genital area
Term
susceptibility
Definition
the likelihood the infectious agent will cause illness in an individual
Term
There are four stages in the human response to pathogens:
Definition
the incubation period, the prodromal stage, the full stage of illness, and the convalescent stage
Term
The incubation period is
Definition
the time from the initial contact or invasion of the pathogen until the first symptoms appear
Term
Many factors affect the length of the incubation period
Definition
- the virulence and time exposed to the pathogen
- the host’s level of susceptibility
Term
prodromal period
Definition
- This is the stage where non-specific symptoms first appear
- the host is most infectious
- can last for a few hours or several days
- Fatigue and a low-grade fever are the most common symptoms at this stage
- infected individuals may not realize they are contagious and therefore the disease spreads at this time
Term
active stage of illness
Definition
- signs and symptoms are very specific and individuals recognize that they are sick
- The symptoms can be localized or systemic
Term
The human body’s defense system fights infection through
Definition
- the body’s inflammatory response
- immune response
Term
Inflammatory response:
Definition
This is the body’s response to injury or invasion by a pathogen
Term
Inflammation - injury
Definition
- the body further controls the invasion by neutralizing the pathogen. The pathogen is neutralized by neutrophils, which surround and consume it.
Term
Inflammatory response - invasion
Definition
The body further controls the invasion by releasing fluid, cells, and other by-products of the inflammatory process from the wound as exudate.
Term
Immune response:
Definition
In this type of defense system, the body identifies the invading microorganisms as foreign bodies or antigens. It then produces antibodies in response to the antigens
Term
types of precautions
Definition
- standard
- transmission based
Term
types of precautions - standard
Definition
These are the basic precautions applicable to all patients in health care settings. You need to use these precautions when there is risk of coming in contact with any body fluid, such as blood, secretions, excretions, mucous membranes, and non-intact skin.
Term
types of precautions - transmission based
Definition
These precautions are used in addition to standard
NUR104: Essentials of Nursing Care: Health Safety Module 6
© Excelsior College 2017
precautions for suspected infections that are transmitted by droplet, airborne, or contact routes.
Term
handwashing
Definition
When visibly dirty  When arriving and leaving patient care unit  After coming into direct contact with blood, body fluids, secretions, excretions, contaminated items  Before and after donning gloves  Between patient contacts
Term
Soiled patient-care equipment
Definition
When handling these, you need to:
 Ensure that there is no transfer of microorganisms to others and to the environment;  Wear gloves if the contamination is visible  Perform hand hygiene
Term
areas of infection control
Definition
- soiled patient care equip
- environmental
- textiles and laundry
- needles and other sharps
- pt resuscitation
- pt placement- respiratory hygiene/cough etiquette
Term
You need to assign single-rooms to patients who are:
Definition
At increased risk of transmission  Likely to contaminate the environment  Not maintaining appropriate hygiene  At increased risk of acquiring infection or developing adverse outcome following infection
Term
Respiratory hygiene/cough etiquette
Definition
(source containment of infectious respiratory secretions in symptomatic patients, beginning at initial point of encounter e.g., triage and reception areas in emergency departments and physician offices):
Term
PPE
Definition
- first perform hand hygiene
- Don PPE in the following sequence: gown, mask, eyewear, and gloves. 
- Select PPE of the correct size.
- Ensure it fits properly and covers all areas it is meant to cover
- Keep hands away from the face. -
- Work from dirty to clean -
- Limit items and surfaces touched.
- Change PPE that is torn or heavily contaminated
Term
PPE sequence to put on
Definition
- gown
- mask
- eyeware
- gloves
Term
Remove PPE
Definition
- at the doorway before leaving the patient’s room or in the anteroom.
-  Do not touch the outer side of the PPE, which is contaminated.
-  Remove PPE in the following sequence: gloves, gown, eyewear, and mask. 
- After removing the gloves and gown, perform hand hygiene before removing the other PPE. 
- Place the used PPE in the appropriate waste container or the receptacle for reprocessing. 
- Perform hand hygiene immediately after removing the PPE.
Term
Remove PPE in the following sequence:
Definition
- gloves
-gown
-eyewear
- mask
Term
Several factors affect how people maintain personal hygiene.
Definition
- culture
- environment
- health
- devp level
- personal preference
Term
asepsis
Definition
- medical
- surgical
Term
medical asepsis
Definition
- clean technique
- handwashing and wearing of gloves
Term
surgical asepsis
Definition
sterile technique
Term
The purpose of medical asepsis is to
Definition
confine pathogens and prevent their transmission to others
Term
The purpose of surgical asepsis is to
Definition
remove pathogenic microbes in order to protect against infection
Term
The practice of hygiene involves
Definition
caring for one’s skin, eyes, ears, nails, teeth, and genital areas
Term
The Nursing Process and Hygiene - assessment
Definition
need to gather data related to the integumentary system, susceptibility to infection, access to basic hygiene facilities, etc
- Some areas to pay attention to are temperature, presence or absence of moisture, any skin lesions, sensation, color, texture, and vascularity
Term
Wounds are classified as:
Definition
Intentional or accidental
Open or closed
Acute or chronic
Term
Wound depth is classified as:
Definition
Partial thickness
Full thickness
Complex
Term
Phases of wound healing:
Definition
Hemostasis: the cessation of bleeding  Inflammation: classic signs are redness, edema, warmth, and pain which typically last four days post injury  Proliferation: wound repair takes place  Maturation: remodeling dermal tissue to close the wound
Term
Factors associated with wound healing:
Definition
Local: extent of trauma, edema, pressure, infection, etc.
Systemic: circulation, nutrition, health status, immune system, medication, and the patient’s age
Term
Factors associated with delayed wound healing:
Definition
Infection
Prolonged bleeding
Term
Complications: in wounds
Definition
Dehiscence: the partial or total separation of the wound edges  Evisceration: complete separation of the wound with protrusion of viscera. This is a medical emergency.
Other considerations:
 Pain: Pain is both a physical and psychological component of the trauma caused by wounds.  Anxiety: Anxiety and fear are common in a patient who has been wounded. Addressing these issues is a very important aspect of caring for the patient.  Change in body image: This can be a major issue for patients, especially when the wound or scar is visible to others.
Term
Factors associated with the development of pressure ulcers include:
Definition
External pressure: Prolonged pressure on the skin and tissues is, by far, the most common cause of pressure ulcers.
Boney prominences, when exposed to such pressure, are especially vulnerable.  Shearing and friction: Sliding down in a bed or chair or being pulled across bed sheets are also likely to cause pressure ulcers.
Term
Risk factors associated with the development of pressure ulcers:
Definition
Immobility: Immobility is one of the primary reasons for the development of pressure ulcers.
Moisture: Moisture due to sweat, urine, and feces removes oil from skin, increasing the damage caused by shear and friction.
Nutrition: Protein malnourishment increases the likelihood of cellular damage. Underweight individuals have increased pressure on bony prominences. Overweight individuals may have decreased circulation to the tissue.
Mental status: Patients who are not fully conscious may not be aware of any physical discomfort or be able to reposition themselves.
Age: As a person ages, the skin becomes thin and fragile, increasing the risk of developing pressure ulcers
Term
The stages in a pressure ulcer include:
Definition
Suspected deep tissue injury: There is purple or maroon discoloration of intact skin or blood-filled blisters resulting from damage of underlying soft tissue.  Stage I: Skin is intact, but not blanchable. 
Stage II: There is partial thickness loss of the dermis, which is shallow with a pink wound bed.
 Stage III: There is full thickness loss of the dermis. Fat may be visible, but no other underlying structures are visible.  Stage IV: There is full thickness loss of dermis with exposed underlying structures such as bones, tendon, and/or muscle. 
Unstageable: There is full thickness loss that is covered by slough and/or eschar
Term
Braden scale for pressure ulcer risk - The lower the individual scores on the Braden Scale, the higher the chances of developing pressure ulcers
Definition
Sensory perception
Moisture
Activity
Mobility
Nutrition
Shear and friction risk
Term
Braden scale
Definition
SEVERE RISK: Total score 9
HIGH RISK: Total score 10-12
MODERATE RISK: Total score 13-14 MILD RISK: Total score 15-18
Term
bacteriostatic
Definition
inhibits growth
Term
bactericidal
Definition
kills growth of bacteria
Term
antibiotics target the processes of the invading organisms
Definition
some go after protein synthesis
some inhibit DNA or RNA synthesis
some destroy the cell wall
Term
drip factor: gtts/ml
Definition
V/t x DF
Term
antibiotics
Definition
penicillin
cephalosporin: 1-3 generations
tetracyclines
macrolides (erythromycin)
aminoglycosides
quinolones (ciproflaxin)
sulfonamides
Term
penicillins
Definition
- skin infections, otitis media, sinusitis, respiratory infections, GU infections
- they kill gram+ and gram– bacteria by destroying the cell walls
Term
cephalosporins
Definition
- can be used for people who can't tolerate penicillins
Term
1st generation cephalosporins
Definition
– used mainly for people allergic to penicillin
they act against gram+ bacteria
Term
2nd generation cephalosporins
Definition
treat nosocomial pneumonia
treat pelvic or intraabdominal infections
Term
3rd generation cephalosporins
Definition
act against gram- bacteria
Term
Tetracyclines
Definition
they prevent bacteria from making protein (protein synthesis)
useful against gram- and gram+ microbes
Term
seborrhea
Definition
a scaly scalp condition often called cradle cap
Term
3 factors to consider when choosing an antibiotic
Definition
- identity of the infecting organism
- drug sensitivity of the infecting organism
- host factors, such as the site of the infection, and the status of host defenses
Term
reasons for choosing a drug of choice
Definition
- greater efficacy
- lower toxicity
- a more narrow spectrum
Term
conditions that might rule out a first-choice drug
Definition
- allergy to 1st drug of choice
- inability of the drug of choice to penetrate to the site of infection
- heightened susceptibility of the pt to toxicity of the first choice drug
Term
quickest, simplest, and most versatile technique to id a m.org
Definition
gram-stained preparation
Term
culture samples should not be exposed to
Definition
- low temp
- antiseptics
- oxygen
Term
microbes that can be detected by a PCR test
Definition
- C. diff
- S. areus
- H. pylori
- HIV
- flu
Term
drug sensitivity tests
Definition
- disk diffusion
- serial dilution
- gradient diffusion
Term
disk diffusion
Definition
testing a bacteria against different zones of an antibiotic to see which one works
Term
serial dilution establishes
Definition
- the minimum inhibitory concentration (MIC), but does not kill
- the minimum bactericidal conc (MBC)
Term
gradient diffusion
Definition
provides a more precise indication of MIC
Term
host defense consists of
Definition
- immune system
- phagocytic cells
Term
the goal of using antibiotics
Definition
- not to totally kill
- to suppress microbial growth enough to give the host defenses a chance to kill it on their own
Term
site of infection
Definition
to be effective, a drug must be at the site of infection and at a greater conc than the MIC
Term
examples of hampered drug penetration
Definition
- meningitis, because of blood-brain barrier
- endocarditis because of bacterial vegetation
- infected abscesses due to poor vascularity, pus and other materials
Term
treating meningitis
Definition
- use drug that crosses blood-brain barrier, or
- inject drug directly into subarachnoid space
Term
treating abscesses with exudate hindering an antibiotic
Definition
- surgical drainage
Term
drugs with high incidences of allergic reactions by pts
Definition
- penicillin
- sulfonamides
- trimethoprim
- erythromycin
Term
genetic factors can influence
Definition
- a pt's response to a drug
- a pt's rate of metabolism
Term
infants and microbials
Definition
- highly vulnerable to drug toxicity
- use of sulfonamides can cause kernicturis
Term
kernicterus
Definition
a severe neurologic disorder caused by displacement of bilirubin from plasma proteins
Term
children/adols and microbials
Definition
tetracyclines cause discoloration of teeth
Term
pregnant women and microbials
Definition
gentamicin can cause irreversible hearing loss in the baby
Term
breast-feeding and microbials
Definition
- sulfonamides in breast milk can cause kernicterus
Term
older adults and microbials
Definition
reduced rates of metabolism and drug excretion can cause accumulation of toxic levels
Term
successful antimicrobial txt requires
Definition
- it must be at the site of infection
- an effective concentration
- at a sufficient amount of time
Term
the desirable antimicrobial concentration
Definition
- 4 to 8 times the MIC
Term
duration of therapy depends on
Definition
- site of infection
- status of host defenses
- the id of an infecting organism
Term
dangers of stopping antibiotics too early
Definition
- recurrent infection
- the organisms are likely to become more drug resistant than when txt began
Term
Universal precautions –
Definition
they interfere with the spread of bloodborne pathogens
Term
Body substance isolation (BSI) –
Definition
it employs generic infection control precautions for all cts except for those with the few diseases xmitted through the air
Term
Transmission-based precautions
Definition
(Tier Two)
airborne
droplet
contact
Term
Donning
Definition
put on gown
put on face mask
don gloves
Term
Removing
Definition
remove gloves first
wash hands
remove face mask
remove gown
Term
Different names are used to identify the same drug and include:
Definition
Generic: This is the official name of the medication. Most drugs are prescribed using the generic name. For example, levothyroxine sodium.  Official: This is how the drug is listed in publications and is almost always the generic name.  Trade/Brand: This is the trademark name used by the drug company. For example, Synthroid.  Chemical: This is the specific chemical description of the drug. For example, l-thyroxine or T4
Term
There are many forms of medication preparations available. Some of the more common types include:
Definition
Pills/capsules/tablets: Used for oral administration and generally absorbed the slowest.  Syrups: Medications that are mixed with water and sugar solution.  Lotions or Ointments: Medication preparation for a topical application.  Powders: Finely ground drugs that can be put into another form, such as a capsule, for administration.  Suppositories: Medication in a form that easily melts for use via the rectum, vagina, or urethra.  Transdermal Patches: Applied directly to the skin for diffusion to the blood stream
Term
routes of drug admin - enteral
Definition
 Oral: Medication is administered by mouth in liquid or pill form.  Via gastrointestinal tubes: Medications are administered through nasogastric, percutaneous endoscopic gastrostomy (PEG) or jejunostomy tubes.  Buccal: Medicine is placed between the gums and cheek.  Sublingual: Medicine is placed under the tongue
Term
routes of drug admin - parenteral
Definition
Intramuscular: Medication is injected into muscle tissue.  Subcutaneous: Drug is injected into the subcutaneous tissue.  Intravenous: Medication is injected directly into the blood stream through a vein
Term
routes of drug admin - topical
Definition
Transdermal: Medicine is administered through the skin.  Instillations: The medication is placed into a body cavity.  Irrigations: A liquid medication is used to wash out a body cavity.  Nebulizers/Metered Dose Inhalers: Medication is inhaled directly into the lungs
Term
pharmacokinetics
Definition
- absorption
- distribution
- metabolism
- excretion
Term
Pharmacodynamics is
Definition
the process in which drugs alter cell physiology to have their desired effect. A drug can change a body’s processes by promoting, turning on, turning off, or blocking normal responses
Term
The types of adverse drug effects are:
Definition
Side effects: Refer to any unintended effect of a drug  Synergistic effects: Drug-to-drug reaction that increases the effect of one or both drugs when used in combination, which could be desirable or undesirable.  Antagonistic effects: Drug-to-drug reaction that decreases the effect of one or both drugs when used in combination, which could be desirable or undesirable.  Toxic effects: Drug effects that could lead to permanent damage or even death.  Idiosyncratic effects: Unpredicted response to a drug that could be opposite to the intended effect.
Allergic response: This is caused when the body identifies a drug as a foreign body and triggers the immune system to respond by producing antibodies. Allergic effects can be minor or lifethreatening. The most serious allergic effect is called an anaphylactic reaction, which is a medical emergency.  Drug tolerance: This is caused when the body becomes accustomed to a particular drug and, therefore, higher doses are necessary to achieve a therapeutic effect
Term
Side effects:
Definition
Refer to any unintended effect of a drug
Term
Synergistic effects:
Definition
Drug-to-drug reaction that increases the effect of one or both drugs when used in combination, which could be desirable or undesirable
Term
Antagonistic effects:
Definition
Drug-to-drug reaction that decreases the effect of one or both drugs when used in combination, which could be desirable or undesirable
Term
Idiosyncratic effects:
Definition
Unpredicted response to a drug that could be opposite to the intended effect
Term
factors that can affect drug metabolism, drug action, and patient adherence
Definition
Gender, economic challenges, lifestyle choices, and dietary practices are
Term
gender
Definition
Drugs can affect women and men in different ways. Gender influences how body fat is distributed in a person. For example, men are more prone to have fat deposits in the stomach region. A patient’s body fat distribution has a minor effect on absorption and distribution of medication
Term
Individual Preferences
Definition
Individual patients may have specific preferences related to taking medications. Individual preferences also play a role in the lifestyle choices of patients. Some examples of individual preferences include favoring syrups rather than pills, timing when medication is taken based on daily schedule and waking or sleeping patterns, using alcohol, tobacco and other drugs, and using alternative medicine
Term
Physical Condition
Definition
The current physical condition of a patient plays an important role in how a medicine affects the patient. Medicines that are known to have severe side effects on a particular organ will have a significant impact on patients in whom the organ is already impaired. Some examples of physical condition impacting drug action are eyesight, physical dexterity, ability to swallow, organ function (affecting excretion and absorption), presence of disease, and presence of food in the system
Term
environmental factors
Definition
Storage of medications, expiration dates, sensory deprivation and overload, and nutritional state are all factors to be considered for medication safety
Term
Psychological Factors
Definition
A patient’s ability to schedule and adhere to a schedule and whether the patient believes the medication will help are important influencers of patients taking their medications. Patients with mental illnesses may have impaired reactions or not take medications as prescribed
Term
serum drug levels
Definition
- therapeutic range
- peak level
- trough
- half life
Term
Therapeutic range is
Definition
the level of drug concentration that produces the desired effect of the drug
Term
The peak serum drug level is
Definition
taken once a drug’s absorption is complete. The peak level will depend on the individual drug and the route in which it was administered. The peak level is the highest concentration serum level of a drug.
Term
drugs
Definition
Question: What is the term for a trademark name by a drug company? Correct Answer: Brand  Question: What is the term for the body becoming unresponsive to the effects to a particular drug? Correct Answer: Drug Tolerance  Question: What is the specific name that describes a drug’s composition? Correct Answer: Chemical  Question: What is the term for the process of elimination of a drug from the body? Correct Answer: Excretion  Question: What is the term for the process in which drugs alter cell physiology to achieve their desired effect? Correct Answer: Pharmacodynamics
Term
drugs
Definition
Question: What is the term for the undesirable effects of a drug? Correct Answer: Adverse Effects  Question: What is the term for the side effect where the body identifies the drug as a foreign body and triggers the immune system to respond with antibodies? Correct Answer: Allergic Response  Question: What is the term for any unintended impacts of a drug? Correct Answer: Side Effects  Question: What is the term for the unpredicted responses to a drug? Correct Answer: Idiosyncratic Effects
Term
drugs
Definition
Question: What is the term for the drug reactions that increase the effect of one or both drugs when used in combination? Correct Answer: Synergistic Effects  Question: What is the term for the drug effects that could lead to permanent damage or even death? Correct Answer: Toxic Effects  Question: What is the official name that is most commonly used to prescribe drugs? Correct Answer: Generic  Question: What is the term for the process of transportation of a drug from where it enters the body to the bloodstream? Correct Answer: Absorption
Term
drugs
Definition
Question: What is the term for how a drug is listed in publications? This name is usually the same as the generic name. Correct Answer: Official  Question: What is the term for the process of the drug spreading through the body and to the tissues? Correct Answer: Distribution  Question: What is the term for the process performed by the liver, where the drug is changed from one form into another? Correct Answer: Metabolism
Term
med errors cause
Definition
7,000 deaths per yr
Term
the most important properties of an ideal drug
Definition
- effectiveness: the most important over all
- safety: even it is admin at high doses over a long period of time
- selectivity: it only elicits the response for which it's given
- there is no such thing as a wholly selective drug
Term
addl properties of an ideal drug
Definition
- reversibility
- predictability
- ease of admin
- freedom from interaction with other drugs
- low cost
- chemical stability: not lose its effectiveness over time
- a simple generic name
Term
the ultimate concern when admin a drug
Definition
intensity of the response
Term
factors that determine the intensity of a drug response
Definition
- prescribed dose
- admin dose
- conc at sites of action
- intensity of responses
Term
proper drug admin depends on
Definition
- patient adherence
- no med errors
Term
pharmacokinetics
Definition
it determines how much of a drug gets to its site of action
Term
the impact of the body on drugs
Definition
- absorption
- distribution
- metabolism
- excretion
Term
pharmacodynamics
Definition
- impact of the drug on the body
- it determines the nature and intensity of the response
- it's influenced by:
- drug-receptor interaction
- pt's functional state
- placebo effects
Term
sources of individual variation
Definition
characteristics unique to each pt can influence p.kinetics and p.dynamics
Term
sources of individual variation
Definition
- variables:
- physiologic
- pathologic
- genetic
- drug interactions
Term
sources of individual variation - physiologic
Definition
age, gender, wt
Term
sources of individual variation - pathologic
Definition
- diminished function of the kidneys and liver
Term
sources of individual variation - genetic
Definition
can alter the metabolism of drugs and predispose the pt to unique drug reactions
Term
application of the nursing process in drug therapy
Definition
directed at individualizing txt which is critical to achieving the therapeutic objective
Term
evaluation stage of drug therapy
Definition
- therapeutic responses
- adverse reactions and interactions
- pt adherence
- pt satisfaction with txt
Term
7 aspects of drug therapy
Definition
- preadmission assessment
- dosage and admin
- evaluating and promoting therapeutic effects
- minimizing adverse effects
- minimizing adverse interactions
- making prn decisions
- managing toxicity
Term
7 aspects of drug therapy - preadmission assessment
Definition
- develop a baseline to evaluate therapeutic and adverse responses
- id high risk pts
- assess pt's capacity for self-care
Term
measures to reduce adverse events
Definition
- id high risk pts through the pt history
- ensuring proper admin through pt education
- teaching pts about activities that might precipitate adverse events
Term
reducing adverse events
Definition
- the major adverse events the drug can produce
- when they are likely to occur
- id early signs
- minimize discomfort and harm
Term
educating the pt on drugs to be given
Definition
- dosage and admin
- drug name (both)
- dosage and admin schedule
- technique of admin
- duration of drug use
- storage
Term
teaching about therapeutic effect
Definition
- what to expect
- how long it will take
- have pt use nondrug techniques also
Term
analysis and nursing diagnosis - 3 phases
Definition
- judge the appropriateness of the prescribed regimen
- id potential health probs the drug might cause
- determine capacity of pt's self-care
Term
highest priority reactions to drugs
Definition
1. life threatening
2. reactions that cause severe, acute discomfort or long term harm
Term
4 major groups of interventions
Definition
- drug admin
- enhancing therapeutic effects
- minimize adverse effects and interactions
- pt education
Term
evaluation
Definition
- lab tests
- observation of the pt
- physical
- pt interviews
Term
evaluating adherence of drug use
Definition
- blood test
- pt interview
- counting pills
- pt understanding of taking the drugs
Term
why a pt won't take a drug
Definition
- too expensive
- too complicated
- bad side effects
- inconvenient dosage schedule
- pt doesn't feel the drug is necessary
Term
federal pure food and drug act 1906
Definition
the first American law to regulate drugs
Term
food, drug, and cosmetic act 1938
Definition
the first legislation to address drug safety
Term
1962, harris-kefauver amendments to the food, drug, and cosmetic act
Definition
- the first law that required that drugs must prove to be effective
- it was retroactive
- required rigorous testing
Term
1970, controlled substance act
Definition
- controlled substances, schedules I-V
- schedule I: no accepted medical use in the US and they have a high potential for abuse
- schedule II-V: accepted medical use in the US and they have a high potential for abuse
Term
1992, fda regulations permit accelerated approval
Definition
- drugs for aids and cancer
Term
the prescription drug fee act, 1992
Definition
it speeds up the review process for new drugs at the cost of the pharmaceutical process
Term
the fda modernization act, 1997
Definition
called for widespread changes in fda regulations
- the FastTrack system established for aids and cancer drugs now includes drugs for other serious or life-threatening conditions
- manufacturers that plan to stop making a drug must inform pts at least 6 months in advance
- a clinical trial database is required for drugs made for serious or life-threatening illnesses
- drug companies can now give prescribers journal articles showing off-label use for their drugs
Term
the best pharmaceuticals for children act, 2002 and the pediatric research equality act, 2003
Definition
designed to promote much needed research on drug safety and efficacy of drugs for children
- it is required by the fda
Term
the fda amendments act, 2007
Definition
the fda requires new testing on drugs already on the market if they cause any problems to pts
- the fda has the authority to restrict or remove the drug
Term
the family smoking prevention and tobacco control act, 2009
Definition
- fda can now regulate cigarettes
Term
rct
Definition
- random
- controlled
- blind
Term
see drug trial stages
Definition
see drug trial stages
Term
preclinical phase, 1-5yrs
Definition
- animals
- tests for toxicities, p.kinetic properties, and potentially useful biologic effects
Term
clinical trials 2-10yrs
Definition
- humans
- 4 phases
Term
clinical trials - phase I
Definition
- healthy volunteers
- evaluates: drug metabolism
- p.kinetics
- drug metabolism
Term
clinical trials - phase II and III
Definition
- patients 5-5000
- determine: therapeutic effects
- dosage range
- safety
- effectiveness
Term
clinical trials - phase IV
Definition
- drug is released for general use
- its effects on the general population is observed
Term
consideration when prescribing a new drug
Definition
be neither the first to adopt the new, nor the last to abandon the old
Term
when considering a generic over a brand
Definition
determine if there is a difference in the absorption rate
Term
p.kinetic processes
Definition
determines the concentration of a drug at its site of action, and thereby determine the intensity and time course of responses
Term
how drugs cross membranes
Definition
- passing through pores
- undergoing xport
- penetrating the membrane directly
Term
P-glycoprotein
Definition
- found in the liver, kidney, placenta, intestine, and brain capillaries
- it can xport a variety of drugs OUT of cells
Term
to cross membranes, most drugs must
Definition
dissolve directly into the lipid bilayer of the membrane
Term
lipid-soluble drugs
Definition
can cross membranes simply
Term
drugs that are polar or ionized
Definition
can't cross membranes simply
Term
absorption is enhanced by
Definition
- rapid drug dissolution
- high lipid solubility of the drug
- a large surface area for absorption
- high blood flow at the site of admin
Term
IV advantages
Definition
- rapid onset
- precise control of drug entering the blood
- suitability for use with lg volumes of fluid
- suitability for irritant drugs
Term
IV disadvantages
Definition
- high cost
- difficulty
- inconvenience
- danger because of irreversibility
- the potential for fluid overload, infection, and embolism
Term
IM advantages
Definition
- suitability for insoluble drugs
- suitability for depot preparations
Term
IM disadvantages
Definition
- inconvenience
- potential for discomfort
Term
subQ advantages
Definition
- suitability for insoluble drugs
- suitability for depot preparations
Term
subQ disadvantages
Definition
- inconvenience
- potential for discomfort
Term
elimination
Definition
metabolism plus excretion
Term
3 ways to cross a cell membrane
Definition
- passage through channels or pores
- passage with the aid of a transport system
- direct penetration of the membrane itself
Term
P-glycoprotein
Definition
- multidrug transporter protein
- transports drugs out of cells
Term
the most common ways drugs enter cells
Definition
- direct penetration of the membrane
- drugs must be lipid soluble in order to do it
Term
polar drugs
Definition
- they are unable to dissolve in the lipid bilayer of the cell membrane
- they are water soluble
Term
ionization
Definition
- when an acid gives up its proton, it becomes negatively charged
- when a base accepts a proton, it becomes positively charged
- acids tend to ionize in basic (alkaline) media
- bases tend to ionize in acidic media
Term
aspirin is an acid
Definition
- it tends to give up its proton (become ionized) in basic media
- in the stomach, an acidic environment, the aspirin becomes nonionized
- it can then cross the cell membrane in the stomach to the bloodstream
- if the aspirin passes from the stomach to the intestine (an alkaline environment)the aspirin reverts back to being ionized and is impeded from being absorbed
-
Term
ion trapping or pH partitioning
Definition
- acid drugs will accumulate on the alkaline side of a pH gradient
- alkaline drugs will accumulate on the acid side of a pH gradient
Term
a practical example of ion trapping
Definition
by manipulating urinary pH, we can employ ion trapping to draw toxic substances (poison) from the blood into the urine, thereby accelerating their removal
Term
factors affecting absorption
Definition
- rate of dissolution
- surface area
- pH partitioning
- blood flow
- lipid solubility
Term
parenteral and enteral
Definition
- injection
- oral
Term
3 ways iv admin can cause embolisms
Definition
- undissolved particles in solution
- a thrombus can break loose
- RBC can get destroyed, debris from the cells can produce embolism
Term
factors that influence absorption of oral admin
Definition
- solubility and stability of the drug
- gastric and intestinal pH
- gastric emptying time
- food in the gut
- coadmin of other drugs
- special coatings on the drug preparation
Term
drugs that are equal in bioavailability
Definition
- the drug is absorbed at the same rate and to the same extent
Term
enteric coated drugs
Definition
- they protect drugs from the acid and pepsin in the stomach
- they protect the stomach from drugs that can cause gastric discomfort
Term
distribution affected by
Definition
- blood flow to the tissues
- the ability of a drug to exit the vascular system
- the ability of a drug to enter cells
Term
two pathologic blockages to blood flow
Definition
- abscesses
- tumors
Term
movement into the interstitial space is not impeded
Definition
- because drugs pass between capillary cells rather than through them
Term
drugs that are able to cross the BBB
Definition
- lipid soluble, or
- have a transport system
Term
P-glycoprotein
Definition
it protects the brain from drugs by pumping drugs out of cells and back into the BBB
Term
metabolism
Definition
- biotransformation
- the enzymatic alteration of drug structure
Term
drug metabolism in the liver
Definition
- hepatic microsomal enzyme system
- P450
Term
6 possible therapeutic consequences of drug metabolism
Definition
- accelerated renal excretion of drugs
- drug inactivation
- inc therapeutic action
- activation of prodrugs
- inc toxicity
- dec toxicity
Term
the most important consequence of drug metabolism
Definition
- promotion of renal drug excretion
- lipid soluble (hydrophobic) drugs must undergo metabolic conversion to water soluble (hydrophilic) forms in order to be excreted by the kidneys
Term
2 important metabolic transformations to enhance excretion
Definition
- glucuronidation
- addition of a hydroxyl group converts a drug into a more polar (less lipid-soluble) form
Term
glucuronidation
Definition
a hydrophilic glucose derivative is attached to phenytoin to make it more water soluble
Term
prodrug
Definition
a compound that is pharmacologically inactive as administered and then undergoes conversion to its active form via metabolism
Term
special considerations in drug metabolism
Definition
- age
- induction and inhibition of drug-metabolizing enzymes
- nutritional status
- competition between drugs
Term
inducers
Definition
- drugs that act on the liver to inc rates of drug metabolism
Term
first-pass effect
Definition
- the rapid hepatic inactivation of certain oral drugs
- to circumvent the first-pass effect, a drug can be given parenterally
Term
substrates
Definition
- drugs that are metabolized by p450 hepatic enzymes
- the rate they are metabolized is influenced by p450 inducers or inhibitors
Term
3 steps of renal excretion
Definition
- glomerular filtration
- passive tubular reabsorption
- active tubular secretion
Term
drugs that are highly lipid soluble
Definition
undergo extensive passive reabsorption back into the blood until they are converted to more polar forms by the liver
Term
for a drug to reach plateau
Definition
about four half-lives
Term
the time required to reach plateau
Definition
is independent of dosage size
Term
to control too much fluctuation between drug levels
Definition
- give smaller doses at shorter intervals (keeping the total daily dose the same)
- use a continuous infusion
- use a depot prep
Term
for a drug with a long half-life
Definition
it may be necessary to use a loading dose to achieve plateau quickly
Term
when a drug is stopped
Definition
94% will be eliminated over 4 half-lives
Term
pharmacodynamics
Definition
the study of the biochemical and physiologic effects of drugs and the molecular mechanisms by which these effects are produced
Term
maximal efficacy
Definition
the biggest effect a drug can produce
Term
potent drug
Definition
- a drug that produces its effects at low doses
Term
potency and efficacy
Definition
they have independent qualities
Term
it's almost always reversible
Definition
the binding of drugs to their receptors
Term
the receptors through which drugs act
Definition
normal points of control for physiologic processes
Term
molecules supplied by the body
Definition
receptor function is regulated by
Term
all that drugs can do at receptors
Definition
mimic or block the action of the body's own regulatory molecules
Term
drugs
Definition
can't give cells new functions
Term
receptors
Definition
they make selective drug action possible
Term
4 primary families of receptors
Definition
- cell membrane-embedded enzymes
- ligand-gated ion channels
- G protein-coupled receptor systems
- transcription factors
Term
selective drug
Definition
- a drug interacts with only one type of receptor
- that receptor type regulates just a few processes
Term
nonselective drug
Definition
- a drug interacts with only one type of receptor
- that receptor type regulates multiple processes
Term
affinity
Definition
refers to the strength of the attraction between a drug and its receptor
Term
drugs with high affinity
Definition
have high potency
Term
intrinsic activity
Definition
the ability of a drug to activate receptors
Term
high maximal efficacy
Definition
drugs with high intrinsic activity have
Term
agonists
Definition
molecules that activate receptors
Term
in terms of the modified occupancy theory
Definition
- agonists have both affinity and high intrinsic activity
- affinity allows them to bind to receptors
- intrinsic activity allows them to activate the receptor after binding
Term
antagonists
Definition
drugs that prevent receptor activation by endogenous regulatory molecules and by other drugs
Term
modified occupancy theory
Definition
- antagonists have affinity for receptors but no intrinsic activity
- affinity allows the antagonist to bind to receptors, but lack of intrinsic activity prevents the bound antagonist from causing receptor activation
Term
antagonists
Definition
they have no observable effects in the absence of agonists
Term
partial agonists can act as agonists if
Definition
there is no full agonist present
Term
partial agonists can act as antagonists if
Definition
a full agonist is present
Term
continuous exposure of cells to agonists
Definition
can result in receptor desensitization (aka refractoriness or down-regulation)
Term
continuous exposure of cells to antagonists
Definition
can result in hypersensitivity (aka supersensitivity)
Term
ED50
Definition
the dose required to produce a defined therapeutic response in 50% of the population
- its good, to weak, or too strong for some people
Term
therapeutic index
Definition
- LD50:ED50 ratio
- it's a measure of a drug's safety
- the higher the dosage has to be to kill 50% of the population, the safer the drug is
- therefore the higher the ratio of LD to ED, the higher the therapeutic index of the drug
Term
potentiative interactions are
Definition
- beneficial when they inc therap effects
- detrimental adverse effects
Term
inhibitory interactions are
Definition
- beneficial when they dec adverse effects
- detrimental when they dec beneficial effects
Term
competition for protein binding sites
Definition
rarely results in a sustained or sig inc in plasma levels of free drug
Term
drugs that induce hepatic drug-metabolizing enzymes
Definition
can accelerate the metabolism of other drugs
Term
when an inducing agent is added to the med regimen
Definition
it may be necessary to inc the dosages of other drugs
Term
when an inducing agent is dc from the med regimen
Definition
dosages of other drugs may need to be reduced
Term
reducing the extent of absorption
Definition
reduces peak therap responses
Term
reducing the rate of absorption
Definition
merely delays the onset of effects
Term
foods may inc drug toxicity
Definition
the combo of MAO inhibitor with tyramine-rich foods
- It's especially found in aged and fermented foods, such as:
Aged cheeses
Smoked fish
Cured meats
Some types of beer
Term
admin drug on an empty stomach
Definition
- one hour before a meal, or two hours after
Term
adverse drug reaction
Definition
any noxious, unintended, and undesired effect that occurs at normal doses
Term
idiosyncratic effect
Definition
an adverse drug reaction based on a genetic predisposition
Term
the intensity of an allergic reaction
Definition
is based on sensitivity, not dosage
Term
drugs that prolong the QT interval
Definition
pose a risk for torsades de pointes, a dysrhythmia that can progress to v-fib
Term
to reduce the risk of serious reactions, the FDA may require mfgs to create a
Definition
- MedGuide for pts, and/or a
- Risk Eval and Mitigation Strategy
Term
three most common fatal med errors
Definition
- giving an overdose
- giving the wrong drug
- using the wrong route
Term
three most common causes fatal med errors
Definition
- human factors: performance or knowledge deficits
- miscommunication: because of bad handwriting
- confusion caused by similarities in drug names
Term
effective measures for reducing med errors
Definition
- using a safety checklist for high-alert drugs
- replacing handwritten med orders
- having a clinical pharmacist accompany ICU physicians on rounds
- avoiding error-prone abbreviations
- helping and encouraging pts to be active and informed in their hc
- med rec whenever a pt undergoes a transition in care
- a bar code system
Term
dosage adjustments made to account for size
Definition
are often based on body surface area, rather than simply on body weight
Term
p.dynamic tolerance
Definition
results from adaptive changes that occur in response to prolonged drug exposure
Term
p.dynamic tolerance
Definition
inc the MEC of a drug
Term
p.kinetic tolerance
Definition
- results from accelerated drug metabolism
- it doesn't inc the MEC
Term
differences in bioavailability
Definition
they matter most for drugs that have a narrow therapeutic range
Term
predictor of drug responses
Definition
- the specific genetic variations and psychosocial factors shared by some group members that can influence drug responses
- not race
Term
major sources of individual variation
Definition
- poor pt adherence
- med errors
Term
absorption of IM drugs
Definition
- in neonates is slower than adults
- in infants is more rapid than adults
Term
neonate are especially sensitive to
Definition
drugs that are eliminated primarily by hepatic metabolism
Term
kids 1-12 yrs
Definition
metabolize drugs faster than adults
Term
excretion
Definition
the process most effected by aging
Term
extent
Definition
the rate of absorption may be slowed in older adults, although the ______ of absorption isn't
Term
plasma conc of lipid-soluble drugs
Definition
may be lower in elderly
Term
plasma conc of water-soluble drugs
Definition
may be higher in the elderly
Term
the most important cause of adverse drug reactions in elderly
Definition
reduced renal function, with resultant drug accumulation
Term
the most important cause of adverse drug reactions in elderly
Definition
reduced renal function, with resultant drug accumulation
Term
factors underlying the inc in adverse reactions include:
Definition
- polypharmacy
- severe illness
- comorbidities
- txt with dangerous drugs
Term
reasons for unintentional nonadherence in elderly
Definition
- complex regimens
- awkward drug pkg
- forgetfulness
- side effects
- low income
- failure to comprehend instructions
Term
75% of nonadherence among the elderly is intentional. reasons include:
Definition
- expense
- side effects
- the pt's conviction that the drug is unnecessary or the dose is too high
Term
BSA or nomogram
Definition
- used to calculate body surface area of a child for drug dosage
- based on ht and wt
Term
orally or IV
Definition
preferred routes for children
Term
extracellular fluid
Definition
intravascular and interstitial fluid
Term
Na and Cl
Definition
the principal ions of ECF
Term
K and Ph
Definition
the principal ions in ICF fluid
Term
osmotic pressure and hydrostatic pressure
Definition
two major pressure gradients created by...
Term
fluid and electrolyte mvmt in the body
Definition
- osmosis
- diffusion
- active transport
- filtration
Term
regulates fluid volume and composition
Definition
- kidneys
- endocrine system
- cv system
- lungs
- gi system
Term
acid-base balancers
Definition
- lungs: CO2 - acid
- kidneys: bicarb and H atoms
Term
acid-base imbalance occurs
Definition
- the normal 20:1 ratio of bicarb to carbonic acid is upset
- imbalances may be either respiratory or metabolic in origin
Term
prepping insulin
Definition
don't mix unmodified insulin with modified insulin
Term
the Z-track method of IM injection
Definition
recommended to prevent discomfort caused by seepage of the med into subQ tissue
Term
human causes of med errors
Definition
- performance deficits (admin a drug IV instead of IM) 30%
- knowledge deficits 14%
- dosage miscalculation 13%
Term
MAR
Definition
it must be checked immediately before admin a drug
Term
must read the drug level at least three times
Definition
- first when getting the drug
- right before pouring the drug
- finally after pouring the drug
Term
checking dosage
Definition
- check what is prescribed
- is the dosage within established guidelines
- is it related to the pt's condition
Term
eval pt's response to a med
Definition
- pt observation
- asking questions about the pt's perspective
- monitoring the pt for adverse effects of the med
Term
correct order of admin a med
Definition
Reviewing the order on the medication administration record 2. Checking the medication label against the physician’s order 3. Preparing the medication 4. Performing a bedside check of the medication 5. Comparing the patient’s ID band with the name and identification number on the medication administration record 6. Administering the medication 7. Documentation
Term
national pt safety goals for meds
Definition
- must use two pt identifiers when providing care
- all meds in perioperative and other procedural areas should be properly labeled
- reduce the likelihood of pt harm associated with the use of anticoag therapy
- maintain and communicate accurate pt med info
Term
med reconciliation
Definition
step 1 - devp a list of scripts and otc the pt is taking
step 2 - devp a list of meds to be prescribed in collaboration with others on the hc team
step 3 - compare these lists of meds so that there is no omission, duplication, errors in dosage, or med interactions
step 4 - a final list is developed following the decision about which meds will be used
step 5 - teach pt to take care of themselves
step 6 - id safety risks for pts
Term
after making a med error
Definition
- assess pt
- notify dr and nurse mgr
- follow any orders prescribed
- write a brief, but thorough, clear, and factual description of the error and the steps that were taken afterwards, in the pt's record
- complete any paperwork mandated by your facility such as a special event or occurrence forms and include all steps taken after the error occurred
- don't document in the pt's record that an event report was completed
Term
60% of med errors
Definition
occur when pts undergo a transition in care
Term
see banned abbreviations on phone
Definition
see banned abbreviations on phone
Term
cause 80% of med error deaths
Definition
- anticoags
- thrombolytics
- neuromuscular blocking agents
Term
causes of med errors
Definition
see phone
Term
fatal med errors
Definition
- giving an overdose 36%
- giving the wrong drug 16%
- using the wrong route 10%
Term
13 major categories of med errors
Definition
see phone
Term
a medguide is required when the fda has determined that
Definition
- pt adherence to directions for drug use is essential for efficacy, or
- pts need to know about potentially serious effects when deciding to use a drug
Term
torsades de pointes
Definition
a dysrhythmia that can progress to v-fib
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